Predicting 6-Year Mortality Risk in Patients With Type 2 Diabetes
Open accessAbstract
OBJECTIVE—The objective of this study was to create a tool that predicts the risk of mortality in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—This study was based on a cohort of 33,067 patients with type 2 diabetes identified in the Cleveland Clinic electronic health record (EHR) who were initially prescribed a single oral hypoglycemic agent between 1998 and 2006. Mortality was determined in the EHR and the Social Security Death Index. A Cox proportional hazards regression model was created using medication class and 20 other predictor variables chosen for their association with mortality. A prediction tool was created using the Cox model coefficients. The tool was internally validated using repeated, random subsets of the cohort, which were not used to create the prediction model. RESULTS—Follow-up in the cohort ranged from 1 day to 8.2 years (median 28.6 months), and 3,661 deaths were observed. The prediction tool had a concordance index (i.e., c statistic) of 0.752. CONCLUSIONS—We successfully created a tool that accurately predicts mortality risk in patients with type 2 diabetes. The incorporation of medications into mortality predictions in patients with type 2 diabetes should improve treatment decisions.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,769 · see citing works
Levey, A. S., Coresh, J., Bolton, K., Culleton, B. F., Harvey, K. S., Ikizler, T. A., Johnson, C. A., Kausz, A., Kimmel, P. L., Kusek, J. W., et al. (2002) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 11,633 · see citing works
Prediction of coronary heart disease using risk factor categories
Wilson, P. W. F., D’Agostino, R. B., Levy, D., Belanger, A. M., Silbershatz, H., & Kannel, W. B. (1998) · Circulation · doi:10.1161/01.cir.97.18.1837 · Cited by 9,581 · see citing works
Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project
Conroy, R. (2003) · European Heart Journal · doi:10.1016/s0195-668x(03)00114-3 · Cited by 5,290 · see citing works
Goodpasture syndrome during the course of a Schönlein-Henoch purpura
Carreras, L., Poveda, R., Bas, J., Mestre, M., Rama, I., & Carrera, M. (2002) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2002.32799 · Cited by 1,474 · see citing works
Diabetes and Glucose Tolerance as Risk Factors for Cardiovascular Disease: The Framingham Study
Kannel, W. B., & McGee, D. L. (1979) · Diabetes Care · doi:10.2337/diacare.2.2.120 · Cited by 1,203 · see citing works
The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56)
STEVENS, R. J., KOTHARI, V., ADLER, A. I., & STRATTON, I. M. (2001) · Clinical Science · doi:10.1042/cs20000335 · Cited by 1,084 · see citing works
Clarke, P. M., Gray, A. M., Briggs, A., Farmer, A. J., Fenn, P., Stevens, R. J., Matthews, D. R., Stratton, I. M., Holman, R. R., & on behalf of the UK Prospective Diabetes Study (UKPDS) Group (2004) · Diabetologia · doi:10.1007/s00125-004-1527-z · Cited by 615 · see citing works
Young, B. A., Lin, E. H. B., Korff, M. V., Simon, G., Ciechanowski, P. S., Ludman, E. J., Everson‐Stewart, S., Kinder, L. S., Oliver, M. M., Boyko, E. J., et al. (2008) · PubMed · Cited by 606 · see citing works
Cause-specific mortality in a population-based study of diabetes.
Moss, S. E., Klein, R., & Klein, R. (1991) · American Journal of Public Health · doi:10.2105/ajph.81.9.1158 · Cited by 315 · see citing works
mice: Multivariate Imputation by Chained Equations
van Buuren, S., & Groothuis‐Oudshoorn, C. G. M. (2006) · doi:10.32614/cran.package.mice · Cited by 256 · see citing works
Relationship between diabetes and mortality: a population study using record linkage.
Morgan, C. L., Currie, C. J., & Peters, J. R. (2000) · Diabetes Care · doi:10.2337/diacare.23.8.1103 · Cited by 182 · see citing works
The prevalence of multiple diabetes‐related complications
Morgan, C. L., Currie, C. J., Stott, N. C. H., Smithers, M., Butler, C., & Peters, J. R. (2000) · Diabetic Medicine · doi:10.1046/j.1464-5491.2000.00222.x · Cited by 145 · see citing works
Gillum, R. F., Mussolino, M. E., & Madans, J. H. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-2-199707150-00003 · Cited by 140 · see citing works
Lee, E. T., Howard, B. V., Wang, W., Welty, T. K., Galloway, J. M., Best, L. G., Fabsitz, R. R., Zhang, Y., Yeh, J. L., & Devereux, R. B. (2006) · Circulation · doi:10.1161/circulationaha.105.593178 · Cited by 106 · see citing works
Yang, X. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.5.451 · Cited by 98 · see citing works
Predicting 6-Year Mortality Risk in Patients With Type 2 Diabetes
Paul, S. K., Coleman, R. L., Price, H. C., & Farmer, A. J. (2009) · Diabetes Care · doi:10.2337/dc09-0183 · Cited by 4 · see citing works
Harrell, F., Jr. (1996) · doi:10.1002/(sici)1097-0258(19960229)15:4
Flagged first, then by citations
1 of the 21 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Diabetes Care · doi:10.2337/dc12-1801 · Cited by 1,274 · see citing works
Diabetes in Older Adults: A Consensus Report
Sue Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12035 · Cited by 548 · see citing works
Defining and measuring completeness of electronic health records for secondary use
Weiskopf, N. G., Hripcsak, G., Swaminathan, S., & Weng, C. (2013) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2013.06.010 · Cited by 367 · see citing works
Pan, A., Wang, Y., Talaei, M., & Hu, F. B. (2015) · Circulation · doi:10.1161/circulationaha.115.017926 · Cited by 343 · see citing works
Mining Electronic Health Records (EHRs): A Survey
Yadav, P., Steinbach, M., Kumar, V., & Simon, G. (2018) · ACM Computing Surveys · doi:10.1145/3127881 · Cited by 299 · see citing works
Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients
McEwen, L. N., Karter, A. J., Waitzfelder, B. E., Crosson, J. C., Marrero, D. G., Mangione, C. M., & Herman, W. H. (2012) · Diabetes Care · doi:10.2337/dc11-2281 · Cited by 121 · see citing works
Antidiabetic Medications and Polypharmacy
Peron, E. P., Ogbonna, K. C., & Donohoe, K. L. (2014) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2014.08.017 · Cited by 103 · see citing works
Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., Nissen, S. E., & Kattan, M. W. (2020) · Diabetes Care · doi:10.2337/dc19-2057 · Cited by 99 · see citing works
Self-citationPredicting the risk of diabetic retinopathy in type 2 diabetic patients
Semeraro, F., Parrinello, G., Cancarini, A., Pasquini, L., Zarra, E., Cimino, A., Cancarini, G. C., Valentini, U., & Costagliola, C. (2011) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2010.12.002 · Cited by 94 · see citing works
Forst, T. M., Markolf Hanefeld, E., Jacob, S., Moeser, G., Schwenk, G., Pfützner, A., & Haupt, A. (2013) · Diabetes and Vascular Disease Research · doi:10.1177/1479164112465442 · Cited by 84 · see citing works
Lagani, V., Koumakis, L., Chiarugi, F., Lakasing, E., & Tsamardinos, I. (2012) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2012.11.003 · Cited by 63 · see citing works
Cosmo, S. D., Copetti, M., Lamacchia, O., Fontana, A., Massa, M., Morini, E., Pacilli, A., Fariello, S., Palena, A. P., Rauseo, A., et al. (2013) · Diabetes Care · doi:10.2337/dc12-1906 · Cited by 59 · see citing works
Learning to predict post-hospitalization VTE risk from EHR data.
Kawaler, E. A., Cobian, A. G., Peissig, P. L., Cross, D., Yale, S., & Craven, M. W. (2012) · PubMed Central · Cited by 52 · see citing works
Valdagni, R., Kattan, M. W., Rancati, T., Yu, C., Vavassori, V., Fellin, G., Cagna, E., Gabriele, P., Mauro, F., Baccolini, M., et al. (2011) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2011.03.028 · Cited by 49 · see citing works
Self-citationHan, K., Yun, J., Park, Y., Ahn, Y., Cho, J., Cha, S., & Ko, S. (2018) · Clinical Epidemiology · doi:10.2147/clep.s169835 · Cited by 44 · see citing works
Predicting 5- and 10-year mortality risk in older adults with diabetes
Griffith, K. N., Prentice, J. C., Mohr, D. C., & Conlin, P. R. (2020) · Diabetes Care · doi:10.2337/dc19-1870 · Cited by 48 · see citing works
Mentz, R. J., Bethel, M. A., Merrill, P., Lokhnygina, Y. V., Buse, J. B., Chan, J. C. N., Felício, J. S., Goodman, S. G., Choi, J., Gustavson, S. M., et al. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.009304 · Cited by 36 · see citing works
Greenberg, J. K., Yan, Y., Carpenter, C. R., Lumba‐Brown, A., Keller, M. S., Pineda, J. A., Brownson, R. C., & Limbrick, D. D. (2017) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2016.4520 · Cited by 35 · see citing works
Kim, S. U., Kim, B. K., Park, J. Y., Kim, D. Y., Ahn, S. H., Park, Y., Han, K., & Lee, S. (2018) · Modern Rheumatology · doi:10.1080/14397595.2018.1558760 · Cited by 32 · see citing works
Raffield, L. M., Hsu, F., Cox, A. J., Carr, J. J., Freedman, B. I., & Bowden, D. W. (2015) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-015-0055-y · Cited by 31 · see citing works
Wan, E. Y. F., Fong, D., Fung, C. S. C., Yu, E. Y. T., Chin, W. Y., Chan, A. K. C., & Lam, C. L. K. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.01.017 · Cited by 29 · see citing works
Hayes, A., Leal, J., Kelman, C., & Clarke, P. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.03189.x · Cited by 23 · see citing works
Prediction of morbidity and mortality in patients with type 2 diabetes
Wells, B. J., Roth, R., Nowacki, A. S., Arrigain, S., Yu, C., Rosenkrans, W. A., & Kattan, M. W. (2013) · PeerJ · doi:10.7717/peerj.87 · Cited by 21 · see citing works
Self-citationCopetti, M., Shah, H., Fontana, A., Scarale, M. G., Menzaghi, C., Cosmo, S. D., Garofolo, M., Sorrentino, M. R., Lamacchia, O., Penno, G., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-00215 · Cited by 20 · see citing works
Development and validation of a predictive risk model for all-cause mortality in type 2 diabetes
Robinson, T., Elley, C. R., Kenealy, T. W., & Drury, P. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.02.015 · Cited by 20 · see citing works
Mining Electronic Health Records: A SurveyPreprint
Yadav, P., Steinbach, M. S., Kumar, V., & Simon, G. (2017) · arXiv (Cornell University) · doi:10.48550/arxiv.1702.03222 · Cited by 20 · see citing works
Hu, W., & Lin, C. (2018) · Clinical Cardiology · doi:10.1002/clc.22991 · Cited by 17 · see citing works
A Point-based Mortality Prediction System for Older Adults with Diabetes
Chang, Y., Huang, L., Shin, S. J., Lin, K., Chong, K., Yen, F., Chang, H., Chuang, S., Hsieh, T.-J., Hsiung, C. A., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-12751-3 · Cited by 16 · see citing works
Karter, A. J., Parker, M. M., Moffet, H. H., Lipska, K. J., Laiteerapong, N., Grant, R. W., Lee, C., & Huang, E. S. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08219-y · Cited by 13 · see citing works
Mukherjee, T., Robbins, T., Keung, S. N. L. C., Sankar, S., Randeva, H. S., & Arvanitis, T. N. (2020) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2020.107705 · Cited by 13 · see citing works
Fabbian, F., Giorgi, A. D., Monesi, M., Pala, M., Tiseo, R., Misurati, E., Parisi, C., Volpi, R., Graziani, R., Mikhailidis, D. P., et al. (2014) · Diabetes and Vascular Disease Research · doi:10.1177/1479164114552656 · Cited by 11 · see citing works
Bujang, M. A., Kuan, P. X., Tiong, X. T., Sapri, F. E., Ismail, M., Mustafa, F. I., & Hamid, A. M. A. (2018) · Journal of Diabetes Research · doi:10.1155/2018/4638327 · Cited by 10 · see citing works
Population stratification in type 2 diabetes mellitus: A systematic review
Hodgson, S., Cheema, S., Rana, Z., Olaniyan, D., O’Leary, E., Price, H. C., & Dambha‐Miller, H. (2021) · Diabetic Medicine · doi:10.1111/dme.14688 · Cited by 9 · see citing works
Qi, J., He, P., Yao, H., Xue, Y., Sun, W. R., Lu, P., Qi, X., Zhang, Z., Jing, R., Cui, B., et al. (2022) · Journal of Diabetes · doi:10.1111/1753-0407.13343 · Cited by 8 · see citing works
Applying the Payoff Time Framework to Carotid Artery Disease Management
Yuo, T. H., Roberts, M. S., Braithwaite, R. S., Chang, C. H., & Kraemer, K. L. (2013) · Medical Decision Making · doi:10.1177/0272989x13491462 · Cited by 7 · see citing works
Barchetta, I., Capoccia, D., Baroni, M. G., Buzzetti, R., Cavallo, M. G., Cosmo, S. D., Leonetti, F., Leotta, S., Morano, S., Morviducci, L., et al. (2015) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2015.09.009 · Cited by 6 · see citing works
Use of the Burden of Diabetes Mellitus Score for Cardiovascular Disease Risk Assessment
Farjo, P. D., Barghouthi, N., Chima, N. R., Desai, A., Fang, W., Giordano, J., & Bianco, C. M. (2020) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2020.03.027 · Cited by 6 · see citing works
Predicting 6-Year Mortality Risk in Patients With Type 2 Diabetes
Wells, B. J., Jain, A., Arrigain, S., Yu, C., Rosenkrans, W. A., & Kattan, M. W. (2009) · Diabetes Care · doi:10.2337/dc09-0327 · Cited by 5 · see citing works
Self-citationVershinina, O., Sabbatinelli, J., Bonfigli, A. R., Colombaretti, D., Giuliani, A., Krivonosov, M., Trukhanov, A., Franceschi, C., Ivanchenko, M., & Olivieri, F. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1689312 · Cited by 4 · see citing works
Adding propensity scores to pure prediction models fails to improve predictive performance
Nowacki, A. S., Wells, B. J., Yu, C., & Kattan, M. W. (2013) · PeerJ · doi:10.7717/peerj.123 · Cited by 4 · see citing works
Self-citationFabbian, F., Giorgi, A. D., Monesi, M., Pala, M., Tiseo, R., Forcellini, S., Storari, A., Graziani, R., Volpi, R., Mikhailidis, D. P., et al. (2015) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2015.05.003 · Cited by 4 · see citing works
Derivation and Validation of a Risk Index to Predict All-Cause Mortality in Type 2 Diabetes Mellitus
Wu, C. X., Tan, W. S., Toh, M. P. H. S., & Heng, B. H. (2012) · Journal of Endocrinology and Metabolism · doi:10.4021/jem.v2i2.67 · Cited by 4 · see citing works
Predicting 6-Year Mortality Risk in Patients With Type 2 Diabetes
Paul, S. K., Coleman, R. L., Price, H. C., & Farmer, A. J. (2009) · Diabetes Care · doi:10.2337/dc09-0183 · Cited by 4 · see citing works
Development and validation of a nomogram of all-cause mortality in adult Americans with diabetes
Shen, X., Zhang, X., Long, Y., Wang, P. F., Zhang, J. F., Song, S. Z., & Jiang, L. (2024) · Scientific Reports · doi:10.1038/s41598-024-69581-3 · Cited by 2 · see citing works
Web Services for Healthcare Management
Grandinetti, L., & Pisacane, O. (2012) · IGI Global eBooks · doi:10.4018/978-1-4666-0203-8.ch004 · Cited by 1 · see citing works
Aminnejad, N., Buajitti, E., Rosella, L. C., & Huang, H. (2025) · Journal of Medical Systems · doi:10.1007/s10916-025-02278-w · Cited by 1 · see citing works
Treatment of cardiovascular risk factors in type 2 diabetes : time trends and clinical practice
Fhärm, E. (2010) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 1 · see citing works
Wagner, S. M. (2011) · ProQuest Demo Repository
Design of a decision support model for the secondary prevention of diabetes
Sangi, M. (2013) · Research Online (University of Wollongong)
Current literature in diabetes
(2009) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.973
KEECH, A. C., O’Connell, R. L., Januszewski, A. S., Li, L., Dalton, C., Simes, R. J., SULLIVAN, D. R., Taskinen, M., Scott, R. S., Best, J. D., et al. (2026) · Diabetologia · doi:10.1007/s00125-026-06848-6
- Authors
- Wells, B. J., Jain, A., Arrigain, S., Yu, C., Rosenkrans, W. A., & Kattan, M. W.
- Affiliations
- Cleveland Clinic (US)
- Massachusetts Institute of Technology (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2008-12-01
- Volume
- 31
- Issue
- 12
- Pages
- 2301-2306
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2584185
- OpenAlex
- W2100982363
- Cited by
- 51
- References
- 21
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 1 · 2018: 6 · 2017: 4 · 2015: 5 · 2014: 2 · 2013: 7 · 2012: 7
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, mortality prediction, predictive tools, oral antidiabetic drugs, medication classes, Cox proportional hazards model, concordance index, internal validation, electronic health records
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Cohort Studies, Proportional Hazards Models, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review